Provider Demographics
NPI:1497251219
Name:LINCOLN COUNTY PUBLIC HOSPITAL DISTRICT 1
Entity Type:Organization
Organization Name:LINCOLN COUNTY PUBLIC HOSPITAL DISTRICT 1
Other - Org Name:ODESSA MEMORIAL HEALTHCARE CENTER HEALTH HOMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SERLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-982-2611
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:WA
Mailing Address - Zip Code:99159-0368
Mailing Address - Country:US
Mailing Address - Phone:509-982-2611
Mailing Address - Fax:509-982-2616
Practice Address - Street 1:502 E AMENDE DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:WA
Practice Address - Zip Code:99159-7003
Practice Address - Country:US
Practice Address - Phone:509-982-2611
Practice Address - Fax:509-982-2616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management